Verity MCP Server

Look up a medical code (CPT, HCPCS, ICD-10, or NDC) and get coverage information. Returns code details, descriptions, RVU values, and related Medicare policies. Use this to understand what a code means and whether it's covered.

Examples:

• lookup_code("76942") - ultrasound guidance

• lookup_code("J0585") - Botox injection

• lookup_code("M54.5") - low back pain diagnosis

Search Medicare coverage policies (LCDs, NCDs, Articles). Use this to find policies related to procedures, conditions, or coverage questions. Supports keyword and semantic search modes.

Examples:

• search_policies("ultrasound guidance") - find policies about ultrasound

• search_policies("diabetes CGM") - find continuous glucose monitor policies

• search_policies("", { policy_type: "NCD" }) - list all National Coverage Determinations

Get detailed information about a specific Medicare coverage policy. Use this after finding a policy ID from search_policies or lookup_code. Can include criteria, codes, attachments, and version history.

Examples:

• get_policy("L33831") - LCD for ultrasound guidance

• get_policy("A52458", { include: "criteria,codes" }) - with coverage criteria

Compare coverage policies across different MAC jurisdictions for specific procedure codes. Useful to understand regional coverage differences for the same procedures. Shows national vs. jurisdiction-specific policies.

Examples:

• compare_policies(["76942"]) - compare ultrasound guidance coverage nationally

• compare_policies(["76942", "76937"], { jurisdictions: ["JM", "JH"] }) - compare specific regions

Track recent changes to Medicare coverage policies. Useful for monitoring updates, new policies, and retirements. Can filter by date, policy ID, or change type.

Examples:

• get_policy_changes() - recent changes

• get_policy_changes({ since: "2024-01-01T00:00:00Z" }) - changes since date

• get_policy_changes({ policy_id: "L33831" }) - changes to specific policy

Search through coverage criteria blocks across Medicare policies. Find specific indications, limitations, or documentation requirements. More targeted than full policy search.

Examples:

• search_criteria("diabetes") - criteria mentioning diabetes

• search_criteria("BMI", { section: "indications" }) - BMI requirements for coverage

• search_criteria("frequency", { section: "limitations" }) - frequency limitations

Get list of Medicare Administrative Contractor (MAC) jurisdictions. Returns MAC names, jurisdiction codes, and covered states. Use this to find the right jurisdiction for a patient's state.

Example:

• list_jurisdictions() - get all MAC jurisdictions and their states

Check if procedures require prior authorization for Medicare. Returns PA requirement, confidence level, matched LCD/NCD policies, and documentation checklist. Essential for determining Medicare coverage requirements before procedures.

Examples:

• check_prior_auth(["76942"]) - check PA for ultrasound guidance

• check_prior_auth(["76942"], { state: "TX" }) - check for Texas patient (determines MAC jurisdiction)

• check_prior_auth(["J0585", "64493"]) - check multiple procedure codes